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1 NURSING PROGRAM FOR NONPUBLIC SCHOOL STUDENTS Based on Current Statute and Code Published August 2014 David C. Hespe Acting Commissioner of Education Evo Popoff Assistant Commissioner Division of Innovation Jessani Gordon Director Office of School Choice and Nonpublic School Services New Jersey Department of Education Division of Innovation 100 River View Plaza PO Box 500 Trenton, NJ

5 PURPOSE This guidance document provides the statute and code relating to nursing services for nonpublic school students. In addition, it includes NJDOE recommendations, entitled NJDOE Guidance, and statute and code clarifications. Links to the code and statutes can be found at: SECTION I DISTRICT NURSING SERVICES FOR NONPUBLIC SCHOOL PUPILS 1 Findings, declarations N.J.S.A. 18A:40-23 The Legislature hereby finds and determines that the welfare of the State requires that all school-age children be assured equal access to appropriate health care services. In order to achieve this objective, it is the intent of the Legislature to require that the State and local communities provide basic nursing services for children in both public and nonpublic schools. Definitions N.J.S.A. 18A:40-24 Nonpublic School means an elementary or secondary school within the State, other than a public school, offering education for grades kindergarten through 12, or any combination of them, wherein any child may legally fulfill compulsory school attendance requirements and which complies with the requirements of Title VI of the Civil Rights Act of Support limit means the maximum amount which may be appropriated each year for the purposes of the act for each pupil enrolled full-time in nonpublic schools of the State. Determination of support limit for school year N.J.S.A. 18A:40-31 The support limit for the school year shall be $ For each school year thereafter the commissioner shall determine the support limit by multiplying the support limit for the previous school year times the sum of 1.0 plus the average annual percentage increase in the consumer price index for the New York and Philadelphia areas during the fiscal year preceding the prebudget year as reported by the United States Department of Labor. On or before November 5 of each year, each board of education shall forward to the commissioner an estimate of the cost of providing, during the next school year, the services required pursuant to this act and the number of pupils attending nonpublic schools located within the district as of the last school day of October of the current school year, excluding those pupils who have refused nursing services pursuant to this act. The commissioner shall provide State aid to each school district in an amount equal to the number of nonpublic school pupils within the district identified by the district on or before November 5 multiplied by the State support limit. In the event that the expenditure incurred by any district is less than the amount of State aid received, the district shall refund the unexpended State aid after the completion of the school year, but not later than December 1 of the following school year. 1 Referenced statute and code are cited verbatim. The statutes and code can be found on the NJDOE website: 5

6 If in any year, the amount of State aid appropriated is insufficient to carry out in full the provisions of this act, the commissioner shall apportion that appropriation among the districts in proportion to the State aid each district would have received had the full amount of State aid been appropriated. In any year, no district shall be required to make expenditures for the purposes of this act in excess of the amount of State aid received for these purposes. Summary of General Nonpublic School Eligibility Requirements Nonpublic School must be registered with New Jersey Department of Education and have completed the Nonpublic Enrollment Report annually. Students must be in grades Kindergarten to 12 AND meet the age requirement of the public school district in the nonpublic school is located. Please note: schools with preschool programs may be asked to provide proof that student enrollment data on the Nonpublic Enrollment Report only counts students in Kindergarten to grade 12. Note: As of May 5, 2014, in accordance with N.J.S.A. 18A: , state funded nonpublic school nursing services providers are permitted to treat pre-k pupils in emergency situations. Students must be enrolled full-time in the nonpublic school. There is no resident requirement for eligible students. School Health and Nursing Services to Nonpublic Schools N.J.S.A. 18A:40-25 through 31 N.J.A.C. 6A:16-2.5; cited below Required services: (a) The district board of education having nonpublic schools within school district boundaries shall provide nursing services to students enrolled in a nonpublic school, pursuant to N.J.S.A. 18A:40-23 et seq., as follows: i. Assistance with medical examinations, including dental screening; ii. Screening of hearing; iii. Maintenance of student health records and notification of local or county health officials of any student who has not been properly immunized, pursuant to N.J.A.C. 8: through 4.20; and iv. Scoliosis examinations of students between the ages of 10 and 18. (b) The district board of education in which the nonpublic school is located shall provide for the extension of emergency care provided to public school students to full-time nonpublic school students who are injured or become ill at school or during participation on a school team or squad, pursuant to N.J.A.C. 6A:16-2.1(a)4. The district board of education may include in its adopted written policies and procedures the provision of nursing services to preschool students enrolled in nonpublic schools in the event of an emergency, pursuant to N.J.S.A. 18A: These health services include: i. The emergency administration of epinephrine via Epi-pen auto-injector pursuant to N.J.S.A. 18A: ; ii. The care of any student who becomes injured or ill while at school or participating in school-sponsored functions; iii. The transportation and supervision of any student determined to be in need of immediate care; and 2 New legislation passed in May

7 iv. The notification to parents of any student determined to be in need of immediate medical care. The nursing services provided to nonpublic schools shall not include instructional services. Additional services: N.J.S.A. 18A:40-26 N.J.A.C. 6A:16-2.5(c), cited below The district board of education having nonpublic schools within school district boundaries may provide additional services to those required above under the following conditions: 1. Such additional medical services may only be provided when all basic nursing services required have been provided, or will be provided; 2. Such additional medical services may include the necessary equipment, materials and services for immunizing students who are enrolled full-time in the nonpublic school from diseases as required by N.J.A.C. 8:57-4, Immunization of Pupils in School; 3. Equipment comparable to that in use in the school district may be purchased by the school district to loan without charge to the nonpublic school for the purpose of providing services under this section. However, such equipment shall remain the property of the district board of education; and 4. Costs of supplies comparable to that in use in the school district and transportation costs may be charged to the funds allocated for each participating nonpublic school provided that they are directly related to the provision of the required basic nursing services and additional medical services which may be provided. NJDOE Guidance The NJDOE strongly recommends that all nursing services for nonpublic schools begin at the start of the school year. Participating Nonpublic Schools Requirements N.J.S.A 18A:40-23 to 31 N.J.A.C. 6A:16-2.5, cited below The chief school administrator of each nonpublic school must: Complete the Nonpublic Enrollment Report annually. Failure to complete this report annually will result in forfeit of services for the following school year. Update school contact information such as address, phone numbers, and addresses with NJDOE. Attend an annual consultation meeting with the local school district. Provide the completed Annual Nonpublic School Nursing Report Form to the local school district at or before the annual consultation meeting. A nonpublic school may decline the nursing services that are required or permitted under this act by submitting written notification to the board of education from the appropriate administrator of the nonpublic school. A pupil who is enrolled in a nonpublic school and whose parent or guardian objects to the pupil receiving any services provided under this act shall not be compelled to receive the services except for a physical or medical examination to determine whether the pupil is ill or infected with a communicable disease. 7

8 NJDOE Guidance The NJDOE recommends that the annual consultation meeting occur prior to June 30 so that services to students can begin at the start of the next school year. Funding notices will not be available until mid July, however the funding information can be shared with the nonpublic schools after the consultations, at which point adjustments to services, service hours and supplies can be made. Although setting up the annual consultation is a requirement of the district, we recommend that the nonpublic reach out to the district as a reminder to set up the meeting, as this will help ensure that it takes place on time. District Board of Education Requirements Consultations N.J.S.A 18A:40-23 to 31 N.J.A.C. 6A:16-2.5(i), cited below The district chief school administrator or his or her designee must meet annually with the nonpublic school administrator for the following purposes: To advise the nonpublic school of the amount of funds allocated to the nonpublic school by the NJDOE for health services; To agree on the basic health services to be provided; To assure that in the event that the chief school administrator or designee and the nonpublic school administrator cannot reach agreement regarding the health services to be provided, the county office of education shall provide assistance; To assure that each nonpublic school that receives nursing services has a copy of the statute (N.J.S.A. 18A:40-23 to 31) and the code (6A:16-2.5) 3 ; To assure that a description of the nursing services provided to the nonpublic school is reflected in the district s Nursing Services Plan. NJDOE Guidance A district representative should be present at consultation meetings since the district is ultimately responsible for the provision of services to the nonpublic schools. If there is an agreement for a third party provider to host the consultation meetings with nonpublic school administrators, it should be included in the contract between the third party provider and the district. No program decisions should be made by the third party provider without detailed agreement with the district as spelled out in the contract with the third party provider and after consultation with nonpublic school administrators. Discussing the needs of the nonpublic school is the primary purpose of the annual consultation. NJDOE has developed a consultation form with the following topics that the chief school administrator or his or her designee and the nonpublic school administrator should discuss: the criteria to be used in the contracting process for nursing service (the public school district should consider the needs and requests of the nonpublic school, including requesting the nurse who will provide services) the start date for nursing service the total nursing service personnel costs to be incurred by the district board of education how the nursing position will be filled in the event of a long-term absence or leave 3 The statute and code can be found on the NJDOE website: 8

9 The NJDOE recommends that districts consider more than the hourly rate and number of service hours when making a decision to hire a nurse or choosing a third party provider. The lowest cost nurse or provider may provide more hours, but may not meet the needs of the nonpublic school or provide the best quality nursing service. Considerations should include the quality of the nursing service provided, the consistency of nursing services from year to year, the number of hours that can be provided, and the specific needs of the nonpublic school when choosing a provider or nurse. NJDOE recommends that consultations be conducted as a face to face meeting with the district and each nonpublic school, but they could be a telephone conference or consultation when a face-to-face meeting is not possible. The NJDOE recommends that consultations occur prior to June 30, and that services to nonpublic school students begin at the start of the school year. If competitive contracting for services is to occur, time to receive and consider the bids is needed. If the consultation occurs before the funding notices have been sent to districts (mid-july), the funding amount can be shared with the nonpublic schools after the consultations, at which point adjustments to services, service hours and supplies can be made. Ideally, consultations should occur more than once a year: prior to the start of the school year and again at the conclusion of the year to determine the effectiveness of the program. 4 If needed, there should be regular communication during the year to discuss any issues with nonpublic programs. It is also recommended that the nonpublic school administrator be notified by the district well in advance of the end of the school year of any funds that are not likely to be spent in the current year. The nonpublic school administrator can make decisions about the use of the remaining funds with sufficient advance notice. Consultation meetings should result in a signed agreement of criteria to be used in the contracting process (if relevant) and the basic health services to be provided. A District Consultation Form has been created for this purpose. District Nursing Services Plan N.J.A.C. 6A:16-2.1(b) Each district board of education shall annually adopt the school district s Nursing Services Plan at the regular meeting and submit it to the county superintendent of education for review and approval and shall include nursing services and additional medical services provided to nonpublic schools. Each district board of education in its determination of the number of certified school nurses and noncertified nurses needed to perform all of the required services, shall consider nursing services and additional medical services provided to nonpublic schools. Fiscal Management N.J.A.C. 6A: The Funding for services shall be based upon the nonpublic school enrollment on the last school day prior to October 16 of the preceding school year. 4 A new law has been proposed that requires that nonpublic schools be consulted when the district plans to change their service provider. 9

10 The provision of services shall be only to students of a nonpublic school that provided to the district board of education a report of the type and number of services provided during the previous school year. The funds expended by the district board of education for administrative costs shall be limited to the actual costs or six percent of the funds allocated for each participating nonpublic school, whichever is less. Statute and code clarifications: This 6% administrative cost is strictly related to the district s responsibility in providing nursing services as defined in the statute and code. These administrative costs include but are not limited to the costs relating to the district's annual consultation, bidding, program and contract management, and oversight and quality control., and are not to be confused with other types of costs over which the Department has no jurisdiction, such as administrative costs that a nursing service agency may build into its service fee. The district may, at its discretion, retain up to 6% to cover its actual administrative costs or pass it on to the third party contractor. The public school district must be able to provide a full accounting of all funds being used for nonpublic nursing. To this end, see the Rationale for the Distribution of Funds in the Monitoring and Recordkeeping section. NJDOE Guidance NJDOE recommends that full disclosure of all funding be provided to the nonpublic school prior to the start of the program. This includes any funding for: District administrative fee (not to exceed 6% based on actual costs) Nursing service hourly rate Number of annual service hours to be provided Any other costs that are being paid with the nonpublic school s allocation, such as health office equipment and supplies Districts Contracting with a Third Party Provider N.J.S.A. 18A: A board of education may join with other boards of education or contract with any public or private agency approved by the commissioner for the provision of nursing services required or permitted. Statute and Code Clarification The public school district may keep any portion of the 6% administrative fee specified in the code, turn the 6% over to the third party provider to administer the program, or split the fee with the third party provider, at their discretion. NJDOE Guidance If a district board of education contracts with a third party provider, it is recommended that the third party provider provide the nursing services specified in 18A:40-25 and 18A:40-26, rather than subcontracting to another provider. Since program delivery is the district s responsibility, intervening providers may make this more challenging and may add additional administrative costs, thereby reducing the funding available for services. 10

11 Use of all administrative fees associated with the program should be written into the contract with the third party. NJDOE recommends that any contracts with third party providers be reviewed on an annual basis and that out-clauses be included to allow for contract termination, should it be needed. Monitoring and Recordkeeping N.J.S.A 18A:40-23 to 31 N.J.A.C. 6A:16-2.5(j) For the purposes of monitoring and recordkeeping, the district board of education providing health services to nonpublic schools shall annually submit the following information to the executive county superintendent of education on or before October 1 and shall provide a copy to the chief school administrator of the nonpublic schools within school district boundaries: 1. A written statement verifying that the required conference was held with the nonpublic school; 2. A copy of the contract with another agency to provide the services, if applicable, and approved minutes of the district board of education meeting approving the contract, which describes the methods by which the health services to nonpublic school students will be provided for the ensuing year, including a rationale for the distribution of funds; and 3. A description of the type and number of services that were provided during the previous school year on a form provided by the NJDOE. The form can be found at: NJDOE Guidance NJDOE recommends that the district s rationale for the distribution of funds for the nursing services to nonpublic school students include: 1. the amount of funds allocated to the nonpublic school by the Department for the provision of nursing services; 2. the start date for services; 3. the nursing services and additional medical services, equipment and supplies to be provided; 4. the nursing rate per hour and the total number of nursing hours to be provided; and 5. the number of nursing hours per week. Summary of Documents District is Required to Provide to Nonpublic School 1. Consultation agreement, including amount of allocation for nursing services and services to be provided 2. Either a written statement or a copy of the contract with another agency to provide services 3. Approved minutes of the district board of education meeting approving the contract 4. Copy of N.J.S.A. 18A:40-23 to 31 and 6A: Copy of the district nursing services plan where it relates to the nonpublic school 11

12 SECTION II HEALTH STATUTES RELATING TO DISTRICT AND NONPUBLIC SCHOOLS The following statutes 5 include school health and nursing services policy and procedural requirements. 18A: Self-administration of medication by pupil permitted. 1. a. A board of education or the governing board or chief school administrator of a nonpublic school shall permit the self-administration of medication by a pupil for asthma or other potentially lifethreatening illnesses or a life-threatening allergic reaction provided that: (1) the parents or guardians of the pupil provide to the board of education or the governing board or chief school administrator of a nonpublic school written authorization for the self-administration of medication; (2) the parents or guardians of the pupil provide to the board of education or the governing board or chief school administrator of a nonpublic school written certification from the physician of the pupil that the pupil has asthma or another potentially life-threatening illness or is subject to a life-threatening allergic reaction and is capable of, and has been instructed in, the proper method of self-administration of medication; (3) the board of education or the governing board or chief school administrator of a nonpublic school informs the parents or guardians of the pupil in writing that the district and its employees or agents or the nonpublic school and its employees or agents shall incur no liability as a result of any injury arising from the self-administration of medication by the pupil; (4) the parents or guardians of the pupil sign a statement acknowledging that the district or the nonpublic school shall incur no liability as a result of any injury arising from the self-administration of medication by the pupil and that the parents or guardians shall indemnify and hold harmless the district and its employees or agents or the nonpublic school and its employees or agents against any claims arising out of the self-administration of medication by the pupil; and (5) the permission is effective for the school year for which it is granted and is renewed for each subsequent school year upon fulfillment of the requirements in paragraphs (1) through (4) of this subsection. b. Notwithstanding any other law or regulation to the contrary, a pupil who is permitted to selfadminister medication under the provisions of this section shall be permitted to carry an inhaler or prescribed medication for allergic reactions, including a pre-filled auto-injector mechanism, at all times, provided that the pupil does not endanger himself or other persons through misuse. c. Any person who acts in good faith in accordance with the requirements of this act shall be immune from any civil or criminal liability arising from actions performed pursuant to this act. L.1993,c.308,s.1; amended 1997, c.21; 2001, c.61, s.1; 2007, c.57, s.1. 5 The statutes and code can be found on the NJDOE website: 12

13 18A: Rules, regulations 2. a. In accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) the State Board of Education shall promulgate such rules and regulations as it deems necessary no later than six months after the effective date of this act. b. A board of education shall not be prohibited from permitting the administration of medication pursuant to section 1 of this act prior to the promulgation of rules and regulations by the State Board of Education. L.1993,c.308,s.2. 18A: Development of policy for emergency administration of epinephrine via pre-filled autoinjector mechanism to pupil. 1. Each board of education or chief school administrator of a nonpublic school shall develop a policy in accordance with the guidelines established by the Department of Education pursuant to section 4 of P.L.2007, c.57 (C.18A: a) for the emergency administration of epinephrine via a pre-filled autoinjector mechanism to a pupil for anaphylaxis provided that: a. the parents or guardians of the pupil provide to the board of education or chief school administrator of a nonpublic school written authorization for the administration of the epinephrine; b. the parents or guardians of the pupil provide to the board of education or chief school administrator of a nonpublic school written orders from the physician or advanced practice nurse that the pupil requires the administration of epinephrine for anaphylaxis; c. the board or chief school administrator of a nonpublic school informs the parents or guardians of the pupil in writing that the district and its employees or agents or the nonpublic school and its employees or agents shall have no liability as a result of any injury arising from the administration of the epinephrine via a pre-filled auto-injector mechanism; d. the parents or guardians of the pupil sign a statement acknowledging their understanding that the district or the nonpublic school shall have no liability as a result of any injury arising from the administration of the epinephrine via a pre-filled auto-injector mechanism to the pupil and that the parents or guardians shall indemnify and hold harmless the district and its employees or agents or the nonpublic school and its employees or agents against any claims arising out of the administration of the epinephrine via a pre-filled auto-injector mechanism; and e. the permission is effective for the school year for which it is granted and is renewed for each subsequent school year upon fulfillment of the requirements in subsections a. through d. of this section. The policy developed by a board of education or chief school administrator of a nonpublic school shall require: (1) the placement of a pupil's prescribed epinephrine in a secure but unlocked location easily accessible by the school nurse and designees to ensure prompt availability in the event of an allergic emergency at school or at a school-sponsored function. The location of the epinephrine shall be indicated on the pupil's emergency care plan. Back-up epinephrine shall also be available at the school if needed; 13

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